Fungal prosthetic joint infection in total hip or knee arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 589-595 ◽  
Author(s):  
C. Theil ◽  
T. Schmidt-Braekling ◽  
G. Gosheger ◽  
E. A. Idelevich ◽  
B. Moellenbeck ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Fungal Infections ◽  
Joint Infection ◽  
Treatment Success ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Total Hip ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Aims Fungal prosthetic joint infections (PJIs) are rare and account for about 1% of total PJIs. Our aim was to present clinical and microbiological results in treating these patients with a two-stage approach and antifungal spacers. Patients and Methods We retrospectively reviewed our institutional database and identified 26 patients with positive fungal cultures and positive Musculoskeletal Infection Society (MSIS) criteria for PJI who were treated between 2009 and 2017. We identified 18 patients with total hip arthroplasty (THA) and eight patients with total knee arthroplasty (TKA). The surgical and antifungal treatment, clinical and demographic patient data, complications, relapses, and survival were recorded and analyzed. Results The median follow-up was 33 months. The success rate was 38.5% (10/26). Fluconazole resistance was found in 15%. Bacterial co-infection was common in 44% of patients for THA and 66% of patients with TKA. Mortality, reoperations, and treatment failure were common complications. Conclusion Treatment with a two-stage exchange is a possible option for treatment, although fungal infections have a high failure rate. Therapeutic factors for treatment success remain unclear. Cite this article: Bone Joint J 2019;101-B:589–595.

scholarly journals Chronic Antibiotic Suppression for Nonstaphylococcal Prosthetic Joint Infections Treated with Debridement or Implant Retention

2021 ◽  
Vol 1 (S1) ◽  
pp. s3-s4
Author(s):  
Poorani Sekar ◽  
Rajeshwari Nair ◽  
Brice Beck ◽  
Bruce Alexander ◽  
Kelly Miell ◽  
...  
Keyword(s):  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Oral Antibiotics ◽  
Musculoskeletal Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
Cas A ◽  
Va Hospitals

Background: Early postoperative and acute prosthetic joint infection (PJI) may be managed with debridement, antibiotics, and implant retention (DAIR). Among patients with nonstaphylococcal PJI, an initial 4–6-week course of intravenous or highly bioavailable oral antibiotics is recommended in the Infectious Diseases Society of America (IDSA) guidelines, with disagreement among committee members on the need for subsequent chronic oral antimicrobial suppression (CAS). We aimed to characterize patients with nonstaphylococcal PJI who received CAS and to compare them to those who did not receive CAS. Methods: This retrospective cohort study included patients admitted to Veterans’ Affairs (VA) hospitals from 2003 to 2017 who had a PJI caused by nonstaphylococcal bacteria, underwent DAIR, and received 4–6 weeks of antimicrobial treatment. PJI was defined by Musculoskeletal Infection Society (MSIS) 2011 criteria. CAS was defined as at least 6 months of oral antibiotics following initial treatment of the PJI. Patients were followed for 5 years after debridement. We used χ2 tests and t tests were used to compare patients who received CAS with those who did not receive CAS. Results: Overall, 561 patients had a nonstaphylococcal PJI treated with DAIR, and 80.6% of patients received CAS. The most common organisms causing PJI were streptococci. We detected no significant differences between patients who received CAS and those who did not receive CAS, except that modified Acute Physiology and Chronic Health Evaluation (mAPACHE) scores were higher among patients who did not receive CAS (Table 1). Conclusion: Patients not on CAS were more severely ill (by mAPACHE) than those on CAS. Otherwise, the 2 groups were not different. This finding was contrary to our hypothesis that patients with multiple comorbidities or higher mAPACHE scores would be more likely to get CAS. A future analysis will be conducted to assess treatment failure in both groups. We hope to find a specific cohort who may benefit from CAS and hope to deimplement CAS in others who may not benefit from it.Funding: NoDisclosures: None

scholarly journals Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Stefano Artiaco ◽  
Andrea Ferrero ◽  
Frediano Boggio ◽  
Giulia Colzani
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Metal Ion ◽  
Clinical Symptoms ◽  
Joint Infection ◽  
Total Hip ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Metal Ion Release ◽  
Prosthetic Joint Infections

Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case ofCandida albicanstotal hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.

scholarly journals Clinical Experience with Tigecycline in the Treatment of Prosthetic Joint Infections

2019 ◽  
Vol 4 (3) ◽  
pp. 126-132
Author(s):  
Allison Lastinger ◽  
Nathanael McLeod ◽  
Matthew J Dietz ◽  
John Guilfoose ◽  
Arif R Sarwari
Keyword(s):  
Joint Infection ◽  
Treatment Success ◽  
Soft Tissue Infections ◽  
Inclusion Criteria ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Mean ◽  
Medical Referral ◽  
Culture Negative

Abstract. Purpose: The purpose of this study was to examine the use of tigecycline in the treatment of prosthetic joint infection (PJI).Methods: This is a retrospective review performed from 2008 to 2017, examining adult patients with PJI at a tertiary medical referral center who received tigecycline for 75% or greater of the treatment course. Failure was defined as need to return to the operating room for an infectious complication or persistent drainage from the joint.Results: A total of 37 patients met inclusion criteria. The median age was 65 years, and 65% of patients were female. The most common reasons for tigecycline use were culture negative infection, polymicrobial infection, and renal failure, but other reasons included antimicrobial allergies and resistant organisms. The mean duration of tigecycline therapy was 40 days (range 28-52 days). Treatment success was documented in 16 cases (43%).Conclusions: Tigecycline is a glycylcycline approved for treatment of a variety of infections including skin and soft tissue infections, but little is known about its use in the treatment of PJI. We found that tigecycline is well-tolerated for prolonged durations. Our success rate was 43%, but the majority of patients in this study had complicated infectious surgical histories and had received prior prolonged courses of antimicrobial therapy which likely affected treatment outcome. We concluded that tigecycline should be reserved as an alternative when other antimicrobials for PJI have been exhausted. More studies are needed to assess tigecycline's use in the treatment of PJI.

scholarly journals Economic Analysis in a Diagnosis Related Groups System for Two-stage Exchange of Prosthetic-joint Infections

2018 ◽  
Vol 3 (5) ◽  
pp. 249-254 ◽  
Author(s):  
Arnaud Fischbacher ◽  
Karine Peltier ◽  
Olivier Borens
Keyword(s):  
Hospital Stay ◽  
Diagnosis Related Groups ◽  
Joint Infection ◽  
Short Interval ◽  
University Hospital ◽  
Two Stage ◽  
Optimal Interval ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract. Background: There is a constant increase of joint arthroplasties performed, with an infectious risk of 1-2%. Different therapeutic options for prosthetic-joint infections exist, but surgery remains essential. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal interval duration between explantation and reimplantation. This retrospective study aimed to assess the economic impact of a two-stage exchange from a single-hospital perspective.Methods: 21 patients who have undergone a two-stage exchange of a hip or knee prosthetic-joint infection at the University Hospital of Lausanne (Switzerland) from 2012 to 2013 were included. The revenues earned according to the Swiss Diagnosis Related Groups (SwissDRG) system introduced in 2012 and the costs were compared for each hospital stay.Results: The remuneration ranged from 26'806 to 42'978 Swiss francs (CHF) (~ 22'905-36'723 EUR, median 36'338 CHF, ~ 31'049 EUR). The median total cost per patient was 76'000 CHF (~ 65'000 EUR) (51'151 to 118'263; hip median 79'744, knee median 66'708). The main determinant of the costs was the length of the hospital stay. Revenues never covered all the costs, even with a short-interval procedure. The hospital lost a median of 35'000 CHF per patient (~ 30'000 EUR) (22'280 to 64'666).Conclusion: The current DRG system may not be specific enough for rewarding prosthetic-joint infections. Several options could be considered to act on the length of the hospital stay. In order to cover costs in complicated cases, such as prosthetic-joint infections, more specific DRGs are needed.

scholarly journals Predicting Success of Two-Stage Exchange for Prosthetic Joint Infection Using C-Reactive Protein/Albumin Ratio

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Cierra S. Hong ◽  
Sean P. Ryan ◽  
Jonathan A. Gabor ◽  
Michael A. Bergen ◽  
Ran Schwarzkopf ◽  
...  
Keyword(s):  
Joint Infection ◽  
Prognostic Scores ◽  
C Reactive Protein ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Total Arthroplasty ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Two-stage exchange is most commonly used for treatment of prosthetic joint infections (PJI) but, this may fail to eradicate infections. C-reactive protein/albumin ratio (CAR) has been used to predict survival and operative success in other surgical subspecialties and so, we assess the association between CAR and reimplantation success during two-stage revision for PJI defined by the Musculoskeletal Infection Society following a primary total hip (THA) or knee (TKA) arthroplasty. From January, 2005 to December, 2015, two institutional databases were queried and patient demographics, antibiotic duration, C-reactive protein, and albumin were collected prior to reimplantation. Two-stage revisions were considered successful if patients were off of antibiotics and did not require a repeat surgery. CAR was available for 79 patients (34 hips and 46 knees) with 61 successful two-stage revisions and 18 failures. The average CAR for patients with successful reimplantation was 1.2 (0.2, 3.0) compared to 1.0 (0.4, 3.2) for treatment failure. However, this was not statistically significant (p=0.766). Therefore, CAR is not applicable in predicting the prognosis of two-stage revisions for PJI in total arthroplasty but other preoperative inflammatory-based prognostic scores should be explored.

Diabetes Mellitus, Hyperglycemia, Hemoglobin A1C and the Risk of Prosthetic Joint Infections in Total Hip and Knee Arthroplasty

2015 ◽  
Vol 30 (3) ◽  
pp. 439-443 ◽  
Author(s):  
Hilal Maradit Kremers ◽  
Laura W. Lewallen ◽  
Tad M. Mabry ◽  
Daniel J. Berry ◽  
Elie F. Berbari ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Knee Arthroplasty ◽  
Hemoglobin A1c ◽  
Total Hip ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hip And Knee Arthroplasty

scholarly journals Low Rate of Microbiologic Relapse in Two-Stage Exchange for Hip Prosthetic Joint Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S90-S90 ◽  
Author(s):  
Michael Henry ◽  
Celeste Russell ◽  
Allina Nocon ◽  
Geoffrey Westrich ◽  
Barry Brause ◽  
...  
Keyword(s):  
Joint Infection ◽  
Univariate Analysis ◽  
Categorical Variables ◽  
Symptom Duration ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Prosthetic Joint ◽  
Obesity And Diabetes ◽  
Prosthetic Joint Infections ◽  
Low Rate

Abstract Background Prosthetic joint infection (PJI) is a grave complication of total hip arthroplasty (THA). Historically, two-stage arthroplasty exchange has been considered to be the definitive approach to eradicating infection and preserving joint function. However, patients are increasingly presenting with higher rates of comorbidities traditionally associated with poorer orthopedic surgical outcome, including advanced age, obesity and diabetes. We investigated whether two-stage exchange remains effective for THR PJI at an orthopedic specialty hospital, and what were the microbiologic etiologies in repeat infections. Methods A retrospective cohort of THA PJI treated with two-stage exchange was identified by query of hospital coding records from 2009 to 2014. The primary endpoint was defined as 2-year implant retention without further surgery. Failure was defined as a recurrence within in 2 years. Microbiologic failure was defined as a recurrence of the previously treated organism. Descriptive statistics were completed using the Fisher’s exact test for categorical variables and the Mann–Whitney U-test for continuous variables. Results One hundred and forty-four patients meeting Musculoskeletal Infection Society International Consensus criteria for THA PJI were identified. The average age was 65 years and 60% were female. One hundred and twenty-seven (88.2%) were cured at 2 years. Pathogens included Staphylococcus aureus (MSSA, 23%; MRSA, 13%), coagulase-negative staphylococci (17%), and streptococci (17%). In univariate analysis, no links were noted between primary outcome and patient age, comorbidities (including diabetes and tobacco), BMI, microbiology, or symptom duration. Of the 17 patients who did not meet criteria for success, 11 (65%) were diagnosed with new, microbiologically distinct infection. The remaining six met our criteria for microbiologic failure; four of the six patients had S. aureus infection (three MSSA). Conclusion We present 2-year outcomes on a large cohort of THA PJI treated with two-stage exchange arthroplasty. Nearly, two-thirds of the patients who failed were found to have a new infection at the time of relapse. Only 4% of the patients in our cohort failed to achieve cure of the primary infection. Two-stage exchange continues to be an effective approach to PJI treatment with a low rate of microbiologic failure. Disclosures All authors: No reported disclosures.

Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection

2021 ◽  
Vol 103-B (8) ◽  
pp. 1373-1379
Author(s):  
Hosam E. Matar ◽  
Benjamin V. Bloch ◽  
Susan E. Snape ◽  
Peter J. James
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Primary Outcome Measure ◽  
Revision Total Knee Arthroplasty ◽  
Single Stage ◽  
Two Stage ◽  
Joint Infections ◽  
Total Knee

Aims Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. Methods A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. Results A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). Conclusion Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373–1379.

scholarly journals Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 872
Author(s):  
Isabel Mur ◽  
Marcos Jordán ◽  
Alba Rivera ◽  
Virginia Pomar ◽  
José Carlos González ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Infection ◽  
Assistive Device ◽  
Matched Cohort ◽  
Knee Prostheses ◽  
Matched Cohort Study ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

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